be perceived.
The stomach was inflamed, both on its outside and inside. It contained a
quantity of bile of the same consistence, but of a blacker colour than
that which was found in the gall bladder. Its villous coat, like that of
the duodenum, was covered with fuzzy and slimy matter. It moreover
appeared to be distended or swelled. This peculiarity in the inner coat
of the stomach was universal in all the bodies that were opened, of
persons who died of this disease.
The lungs, instead of being collapsed, were inflated as in inspiration.
They were all over full of black or livid spots. On these spots were to
be seen small vesicles or blisters, like those of an erysipelas or
gangrene, containing a yellow humour.
The blood-vessels in general seemed empty of blood, even the vena cava
and its branches; but the vena portarum was full and distended as usual.
The blood seemed _collected_ in the _viscera_; for upon cutting the lungs
or sound liver or spleen, they bled freely.
The brain was not opened in this body, but it was not affected in three
others whose brains were examined.
Dr. Mackittrick, in his inaugural dissertation, published at Edinburgh in
the year 1766, "De Febre Indiæ Occidentalis, Maligna Flava," or upon the
yellow fever of the West-Indies, says, that in some of the patients who
died of it, he found the liver sphacelated, the gall bladder full of
black bile, and the veins turgid with black fluid blood. In others he
found the liver no ways enlarged, and its "texture only vitiated." The
stomach, the duodenum, and ilium, were remarkably inflamed in all cases.
The pericardium contained a viscid yellow serum, and in a larger quantity
than common. The urinary bladder was a little inflamed. The lungs were
sound.
Dr. Hume, in describing the yellow fever of Jamaica, informs us, that in
several dead bodies which he opened, he found the liver enlarged and
turgid with bile, and of a pale yellow colour. In some he found the
stomach and duodenum inflamed. In one case he discovered black spots in
the stomach, of the size of a crown piece. To this account he adds, "that
he had seen some subjects opened, on whose stomachs _no marks of
inflammation_ could be discovered; and yet these had excessive vomiting."
Dr. Lind has furnished us with an account of the state of the body after
death, in his short history of the yellow fever, which prevailed at
Cadiz, in the year 1764. "The stomach (he says), mesentery, and
intestines, were covered with gangrenous spots; there were ulcers on the
orifice of the stomach, and the liver and lungs were of a putrid colour
and texture[54]."
[54] Diseases of Warm Climates, p. 125.
To these accounts of the morbid appearances of the body after death from
the yellow fever I shall only add the account of several dissections,
which was given to the public in Mr. Brown's Gazette, during the
prevalence of this epidemic, by Dr. Physick and Dr. Cathrall.
"Being well assured of the great importance of dissections of morbid
bodies in the investigation of the nature of diseases, we have thought it
of consequence that some of those dead of the present prevailing
malignant fever should be examined; and, without enlarging on our
observations, it appears at present sufficient to state the following
facts.
"1st. That the brain in all its parts has been found in a natural
condition.
"2d. That the viscera of the thorax are perfectly sound. The blood,
however, in the heart and veins is fluid, similar, in its consistence, to
the blood of persons who have been hanged, or destroyed by electricity.
"3d. That the stomach, and beginning of the duodenum, are the parts that
appear most diseased. In two persons who died of the disease on the 5th
day, the villous membrane of the stomach, especially about its smaller
end, was found highly inflamed; and this inflammation extended through
the pylorus into the duodenum, some way. The inflammation here was
exactly similar to that induced in the stomach by acrid poisons, as by
arsenic, which we have once had an opportunity of seeing in a person
destroyed by it.
"The bile in the gall-bladder was quite of its natural colour, though
very viscid.
"In another person, who died on the 8th day of the disease, several spots
of extravasation were discovered between the membranes, particularly
about the smaller end of the stomach, the inflammation of which had
considerably abated. Pus was seen in the beginning of the duodenum, and
the villous membrane at this part was thickened.
"In two other persons, who died at a more advanced period of the disease,
the stomach appeared spotted in many places with extravasations, and the
inflammation disappeared. It contained, as did also the intestines, a
black liquor, which had been vomited and purged before death. This black
liquor appears clearly to be an altered secretion from the liver; for a
fluid in all respects of the same qualities was found in the gall
bladder. This liquor was so acrid, that it induced considerable
inflammation and swelling on the operator's hands, which remained some
days. The villous membrane of the intestines, in these last two bodies,
was found inflamed in several places.
"The liver was of its natural appearance, excepting in one of the last
persons, on the surface of which a very few distended veins were seen:
all the other abdominal viscera were of a healthy appearance.
"The external surface of the stomach, as well as of the intestines, was
quite free from inflammation; the veins being distended with blood, which
appeared through the transparent peritonium, gave them a dark colour.
"The stomach of those who died early in the disease was always
contracted; but in those who died at a more advanced period of it, where
extravasations appeared, it was distended with air.
"P. S. PHYSICK,
"J. CATHRALL."
I have before remarked, that these dissections were made early in the
disease, and that Dr. Annan attended a dissection of a body at
Bush-hill, some time afterwards, in which an unusual turgescence appeared
in the vessels of the brain.
Thus far have I delivered the history of the yellow fever, as it affected
the human body with sickness and death. I shall now mention a few of
those circumstances of public and private distress which attended it. I
have before remarked, that the first reports of the existence of this
fever were treated with neglect or contempt. A strange apathy pervaded
all classes of people. While I bore my share of reproach for "terrifying
our citizens with imaginary danger," I answered it by lamenting "that
they were not terrified enough." The publication from the college of
physicians soon dissipated this indifference and incredulity. Fear or
terror now sat upon every countenance. The disease appeared in many parts
of the town, remote from the spot where it originated; although, for a
while, in every instance, it was easily traced to it. This set the city
in motion. The streets and roads leading from the city were crowded with
families flying in every direction for safety to the country. Business
began to languish. Water-street, between Market and Race-streets, became
a desert. The poor were the first victims of the fever. From the sudden
interruption of business they suffered for a while from poverty as well
as from disease. A large and airy house at Bush-hill, about a mile from
the city, was opened for their reception. This house, after it became the
charge of a committee appointed by the citizens on the 14th of September,
was regulated and governed with the order and cleanliness of an old and
established hospital. An American and French physician had the exclusive
medical care of it after the 22d of September.
The disease, after the second week in September, spared no rank of
citizens. Whole families were confined by it. There was a deficiency of
nurses for the sick, and many of those who were employed were unqualified
for their business. There was likewise a great deficiency of physicians,
from the desertion of some, and the sickness and death of others. At one
time there were but three physicians who were able to do business out of
their houses, and at this time there were probably not less than 6000
persons ill with the fever.
During the first three or four weeks of the prevalence of the disease I
seldom went into a house the first time, without meeting the parents or
children of the sick in tears. Many wept aloud in my entry, or parlour,
who came to ask for advice for their relations. Grief after a while
descended below weeping, and I was much struck in observing that many
persons submitted to the loss of relations and friends without shedding a
tear, or manifesting any other of the common signs of grief.
A cheerful countenance was scarcely to be seen in the city for six weeks.
I recollect once, in entering the house of a poor man, to have met a
child of two years old that smiled in my face. I was strangely affected
with this sight (so discordant to my feelings and the state of the city)
before I recollected the age and ignorance of the child. I was confined
the next day by an attack of the fever, and was sorry to hear, upon my
recovery, that the father and mother of this little creature died a few
days after my last visit to them.
The streets every where discovered marks of the distress that pervaded
the city. More than one half the houses were shut up, although not more
than one third of the inhabitants had fled into the country. In walking
for many hundred yards, few persons were met, except such as were in
quest of a physician, a nurse, a bleeder, or the men who buried the dead.
The hearse alone kept up the remembrance of the noise of carriages or
carts in the streets. Funeral processions were laid aside. A black man,
leading or driving a horse, with a corpse on a pair of chair wheels, with
now and then half a dozen relations or friends following at a distance
from it, met the eye in most of the streets of the city, at every hour of
the day, while the noise of the same wheels passing slowly over the
pavements, kept alive anguish and fear in the sick and well, every hour
of the night[55].
[55] In the Life of Thomas Story, a celebrated preacher among the
friends, there is an account of the distress of the city, in its
infant state, from the prevalence of the yellow fever, in the
autumn of 1699, nearly like that which has been described. I shall
insert the account in his own words. "Great was the fear that fell
on all flesh. I saw no lofty or airy countenance, nor heard any
vain jesting to move men to laughter. Every face gathered
paleness, and many hearts were humbled, and countenances fallen
and sunk, as such that waited every moment to be summoned to the
bar, and numbered to the grave." The same author adds, that six,
seven, and sometimes eight, died of this fever in a day, for
several weeks. His fellow-traveller, and companion in the
ministry, Roger Gill, discovered upon this occasion an
extraordinary degree of christian philanthropy. He publicly
offered himself, in one of the meetings of the society, as a
sacrifice for the people, and prayed that "God would please to
accept of his life for them, that a stop might be put to the
contagion." He died of the fever a few days afterwards.
But a more serious source of the distress of the city arose from the
dissentions of the physicians, about the nature and treatment of the
fever. It was considered by some as a modification of the influenza, and
by others as the jail fever. Its various grades and symptoms were
considered as so many different diseases, all originating from different
causes. There was the same contrariety in the practice of the physicians
that there was in their principles. The newspapers conveyed accounts of
both to the public, every day. The minds of the citizens were distracted
by them, and hundreds suffered and died from the delays which were
produced by an erroneous opinion of a plurality of diseases in the city,
or by indecision in the choice, or a want of confidence in the remedies
of their physician.
The science of medicine is related to every thing, and the philosopher as
well as the christian will be gratified by knowing the effects of a great
and mortal epidemic upon the morals of a people. It was some alleviation
of the distress produced by it, to observe its influence upon the
obligations of morality and religion. It was remarked during this time,
by many people, that the name of the Supreme Being was seldom profaned,
either in the streets, or in the intercourse of the citizens with each
other. But two robberies, and those of a trifling nature, occurred in
nearly two months, although many hundred houses were exposed to plunder,
every hour of the day and night. Many of the religious societies met two
or three times a week, and some of them every evening, to implore the
interposition of Heaven to save the city from desolation. Humanity and
charity kept pace with devotion. The public have already seen accounts of
their benevolent exercises in other publications. It was my lot to
witness the uncommon activity of those virtues upon a smaller scale. I
saw little to blame, but much to admire and praise in persons of
different professions, both sexes, and of all colours. It would be
foreign to the design of this work to draw from the obscurity which they
sought, the many acts of humanity and charity, of fortitude, patience,
and perseverance, which came under my notice. They will be made public
and applauded elsewhere.
But the virtues which were excited by our calamity were not confined to
the city of Philadelphia. The United States wept for the distresses of
their capital. In several of the states, and in many cities and villages,
days of humiliation and prayer were set apart to supplicate the Father of
Mercies in behalf of our afflicted city. Nor was this all. From nearly
every state in the union the most liberal contributions of money,
provisions, and fuel were poured in for the relief and support of such
as had been reduced to want by the suspension of business, as well as by
sickness and the death of friends.
The number of deaths between the 1st of August and the 9th of November
amounted to four thousand and forty-four. I shall here insert a register
of the number which occurred on each day, beginning on the 1st of August,
and ending on the 9th of November. By comparing it with the register of
the weather it will show the influence of the latter on the disease.
Several of the deaths in August were from other acute diseases, and a few
in the succeeding months were from such as were of a chronic nature.
died. |
August 1 9 |
2 8 |
3 9 |
4 10 |
5 10 |
6 3 |
7 12 |
8 5 |
9 11 |
10 6 |
11 7 |
12 5 |
13 11 |
14 4 |
15 9 |
16 7 |
17 6 |
18 5 |
19 9 |
20 7 |
21 8 |
22 13 |
23 10 |
24 17 |
25 12 |
26 17 |
27 12 |
28 22 |
29 24 |
30 20 |
31 17 |
September 1 17 |
2 18 |
3 11 |
4 23 |
5 20 |
6 24 |
7 18 |
8 42 |
9 32 |
10 29 |
11 23 |
12 33 |
13 37 |
14 48 |
15 56 |
16 67 |
17 81 |
18 68 |
19 61 |
20 67 |
21 57 |
22 76 |
23 68 |
24 96 |
25 87 |
26 52 |
27 60 |
28 51 |
29 57 |
30 63 |
October 1 74 |
2 66 |
3 78 |
4 58 |
5 71 |
6 76 |
7 82 |
8 90 |
9 102 |
10 93 |
11 119 |
12 111 |
13 104 |
14 81 |
15 80 |
16 70 |
17 80 |
18 59 |
19 65 |
20 55 |
21 59 |
22 82 |
23 54 |
24 38 |
25 35 |
26 23 |
27 13 |
28 24 |
29 17 |
30 16 |
31 21 |
November 1 13 |
2 21 |
3 15 |
4 15 |
5 14 |
6 11 |
7 15 |
8 8 |
9 6 |
---- |
Total[56] 3881 |
[56] In the above accounts there is a deficiency of returns from
several grave-yards of 163.
From this table it appears that the principal mortality was in the second
week of October. A general expectation had obtained, that cold weather
was as fatal to this fever as heavy rains. The usual time for its arrival
had come, but the weather was still not only moderate, but warm. In this
awful situation, the stoutest hearts began to fail. Hope sickened, and
despair succeeded distress in almost every countenance. On the
_fifteenth_ of October, it pleased God to alter the state of the air.
The clouds at last dropped health in showers of rain, which continued
during the whole day, and which were succeeded for several nights
afterwards by cold and frost. The effects of this change in the weather
appeared first in the sudden diminution of the sick, for the deaths
continued for a week afterwards to be numerous, but they were of persons
who had been confined before, or on the day in which the change had taken
place in the weather.
The appearance of this rain was like a dove with an olive branch in its
mouth to the whole city. Public notice was given of its beneficial
effects, in a letter subscribed by the mayor of Philadelphia, who acted
as president of the committee, to the mayor of New-York. I shall insert
the whole of this letter. It contains, besides the above information, a
record of the liberality of that city to the distressed inhabitants of
Philadelphia.
"SIR,
"I am favoured with your letter of the 12th instant, which I have
communicated to the committee for the relief of the poor and afflicted of
this city.
"It is with peculiar satisfaction that I execute their request, by
making, in their name, on behalf of our suffering fellow-citizens, the
most grateful acknowledgements for the seasonable benevolence of the
common council of the city of New-York. Their sympathy is balm to our
wounds.
"We acknowledge the Divine interposition, whereby the hearts of so many
around us have been touched with our distress, and have united in our
relief.
"May the Almighty Disposer of all events be graciously pleased to protect
your citizens from the dreadful calamity with which we are now visited;
whilst we humbly kiss the rod, and improve by the dispensation.
"The part, sir, which you personally take in our afflictions, and which
you have so pathetically expressed in your letter, excites in the breasts
of the committee the warmest sensations of fraternal affection.
"The refreshing rain which fell the day before yesterday, though light,
and the cool weather which hath succeeded, appear to have given a check
to the prevalence of the disorder: of this we have satisfactory proofs,
as well in the decrease of the funerals, as in the applications for
removal to the hospital.
"I have, at your request, this day drawn upon you, at sight, in favour of
the president and directors of the Bank of North America, for the sum of
five thousand dollars, the benevolent donations of the common council of
the city of New-York.
"With sentiments of the greatest esteem and regard,
"I am, sir,
"Your most obedient humble servant,
"MATTH. CLARKSON.
_"Philadelphia, Oct. 17, 1793._
_"Richard Varick, mayor of the city of New-York."_
It is no new thing for bilious fevers, of every description, to be
checked or subdued by _wet_ and _cold_ weather.
The yellow fever which raged in Philadelphia in 1699, and which is taken
notice of by Thomas Story in his journal, ceased about the latter end of
October, or the beginning of November. Of this there are satisfactory
proofs, in the register of the interments in the friends' burying-ground,
and in a letter, dated November 9th, old style, 1699, from Isaac Norris
to one of his correspondents, which his grandson, Mr. Joseph P. Norris,
politely put into my hands, with several others, which mention the
disease, and all written in that memorable year in Philadelphia. The
letter says, "It has pleased God to put a stop to our sore visitation,
and town and country are now generally healthy." The same disease was
checked by wet and cold weather in the year 1741. Of this there is a
proof in a letter from Dr. Franklin to one of his brothers, who stopped
at Burlington, on his way from Boston to Philadelphia, on account of the
fever, until he was assured by the doctor, that a thunder gust, which had
cooled the air, had rendered it safe for him to come into the city[57].
Mr. Lynford Lardner, in a letter to one of his English friends, dated
September 24, 1747, old style, after mentioning the prevalence of the
fever in the city, says, "the weather is now much cooler, and those under
the disorder revive. The symptoms are less violent, and the fever
gradually abates."
[57] From a short note in the register of the interments in the
friends' burying-ground, it appears that the fever this year made
its first appearance in the month of June. The following is a copy
of that note: "12th of the 6th month (O. S.), 1741, a malignant
yellow fever now spreads much." Besides that note, there is the
following: "25th of the 7th month (O. S.), 1741, many who died of
the above distemper were persons lively, and strong, and in the
prime of their time."
I have in vain attempted to procure an account of the time of the
commencement of cold weather in the autumn of 1762. In the short history
of the fever of that year, which I have inserted from my note book, I
have said that it continued to prevail in the months of November and
December. The register of the interments in the friends' burying-ground
in those months confirms that account. They were nearly as numerous in
November and December as in September and October, viz. in September 22,
in October 27, in November 19, and in December 26.
The bilious remitting fever of 1780 yielded to cool weather, accompanied
by rain and an easterly wind[58].
[58] Vol. i.
Sir John Pringle will furnish ample satisfaction to such of my readers as
wish for more proofs of the efficacy of heavy rains, and cold weather, in
checking the progress and violence of autumnal remitting fevers[59].
[59] P. 5, 56, 180, and 323.
From the 15th of October the disease not only declined, but assumed more
obvious inflammatory symptoms. It was, as in the beginning, more
necessarily fatal where left to itself, but it yielded more certainly to
art than it did a few weeks before. The duration of it was now more
tedious than in the warmer weather.
There were a few cases of yellow fever in November and December, after
the citizens who had retired to the country returned to the city.
I heard of but three persons who returned to the city being infected with
the disease; so completely was its cause destroyed in the course of a few
weeks.
In consequence of a proclamation by the governor, and a recommendation by
the clergy of Philadelphia, the 12th of December was observed as a day
of thanksgiving throughout the state, for the extinction of the disease
in the city.
It was easy to distinguish, in walking the streets, the persons who had
returned from the country to the city, from those who had remained in it
during the prevalence of the fever. The former appeared ruddy and
healthy, while the latter appeared of a pale or sallow colour.
It afforded a subject of equal surprise and joy to behold the suddenness
with which the city recovered its former habits of business. In the
course of six weeks after the disease had ceased, nothing but fresh
graves, and the black dresses of many of the citizens, afforded a public
trace of the distress which had so lately prevailed in the city.